The composition of the hospital nurse workforce and effects on patient outcomes is an important area of inquiry because compositional factors are reasonably amenable to managerial modification, compared, for example, to changing something like the culture of safety. Aiken's work on nurses'educational composition, as well as her research on permanent versus temporary nurse composition, suggests there may be multiple nurse compositional factors that impact patient outcomes. This proposal seeks to explore the impact of an unstudied compositional variable on patient outcomes: the association, if any, between the proportions of a hospital's nurse workforce educated abroad and patient outcomes. To be clear, the focus of this proposal is on the compositional effects of nursing on patient outcomes using international nurse graduates (INGs) as a case example. The aims of this study are;1) To determine whether there is significant variation across hospitals in international nurse graduates as a proportion of all direct care nurses, 2) To determine whether patient outcomes vary by the proportion of clinical care nurses within a hospital who have been educated abroad as compared to those who received their basic nursing education in the US, after controlling for patient risk factors and hospital characteristics, and 3) To determine whether any negative outcomes associated with high use of international nurse graduates can be explained by poor patient-to-nurse staffing and/or poor nurse work environments. I am proposing a career development plan in which I will dedicate 75 percent effort to didactic and mentored research activities for the purpose of gaining the following proficiencies: 1) sophistication in statistical methodology and computer applications necessary for doing health services research;2) development in organization and outcomes research, theory, and methodology, particularly as these apply to studies of patient and nurse outcomes and to health care settings;and 3) knowledge and development of health policy. These skills will provide me with the momentum to move forward in developing a unique research focus, and the Mentored Research Career Award will help me be competitive for new research project funding. This period of mentored research, training and didactic coursework will be facilitated by guidance from mentors at the UF College of Nursing, the Department of Health Services Research, Management, and Policy, and the Center for Health Outcomes and Policy Research at the University of Pennsylvania. Mentored time will also allow me to reach my goal of transitioning from a K award to an investigator-initiated grant proposal to continue research in patient and nurse outcomes, nurse practice environments, and organization characteristics as correlates of quality of patient. PUBLIC HEALTH RELEVANCE: The Mentored Research Scientist Development Award is an excellent fit with my immediate goal of scrutinizing one compositional factor of the nurse workforce among multiple hospitals-International Nurse Graduates-as a case example of their potential impact on patient outcomes. It will afford me the protected time needed to gain enough experience to independently pursue my next research goal: funding for an R01 that will help me better understand determinants of patient health outcomes and identify leverage points for improving the systems in which they receive care.